1063032597 NPI number — VICTORY CLINICAL RESEARCH

Table of content: DR. TAMMY LYNN BIALEK D.C. (NPI 1548347917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063032597 NPI number — VICTORY CLINICAL RESEARCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORY CLINICAL RESEARCH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063032597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8508 CEDAR CHASE DRIVE
Provider Second Line Business Mailing Address:
VICTORY ADMIN OFFICE
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-728-5004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7212 HANOVER PARKWAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-441-1704
Provider Business Practice Location Address Fax Number:
301-441-1851
Provider Enumeration Date:
04/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ABIONA
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL SITE DIRECTOR
Authorized Official Telephone Number:
301-728-5004

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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